Dacryocystorhinostomy (DCR) is a surgical procedure aimed at creating a new passage between the tear drainage system of the eye and the nose when the nasolacrimal duct is blocked. Blockage can lead to excessive tearing or recurrent infections.
Why might the tear drainage system malfunction?
Blockages can occur due to repeated infections, trauma, or surgeries involving the eyelids or nose. Aging can also contribute to narrowing of the tear ducts. In many cases, the exact cause of the obstruction remains unknown.
How does the tear drainage system normally work?
Tears lubricate the eye’s surface and drain through the tear puncta in the eyelids, into small canals, and eventually into the nose via the nasolacrimal duct. The muscular tone of the eyelids plays a crucial role in this drainage process.
The most common site of obstruction is the nasolacrimal duct. This can be bypassed through DCR surgery, allowing tears to flow directly into the nose.
What does DCR surgery involve?
During DCR, a new drainage pathway is created to bypass the blockage. The procedure can be performed using two approaches:
- External DCR: Through a small incision on the skin near the nose.
- Endoscopic DCR: Using a camera through the nasal cavity.
The choice of approach depends on individual suitability, which is discussed with the surgeon.
The surgery lasts about an hour and can be performed under local anesthesia with sedation or general anesthesia. Most patients do not require an overnight hospital stay.
External DCR
This involves a 1 cm incision near the nose, where glasses rest. A hole is made in the bone, connecting the tear sac to the nasal cavity above the blockage. Silicone tubes are temporarily placed to aid healing and are removed after 6–8 weeks. Dissolvable stitches close the incision. Success rates are 90–95%.
Endoscopic DCR
This minimally invasive method uses no external incision, leaving no visible scars. The surgeon accesses the tear system through the nostril using a small camera. Silicone tubes are placed and removed after 6–8 weeks. Success rates are slightly lower (85–90%) due to a smaller bone opening.
Risks of DCR
- Nasal bleeding
- Eyelid bruising
- Infection
- Scarring (external DCR)
- Recurrence of symptoms (tearing)
Evangelos Lokovitis MD, FEBOphth
Ophthalmic Surgeon
Specialist in Oculoplastics, Lacrimal & Orbital Surgery
Ophthalmica Institute